| Objective Making random flap model of the different Length to width ratio pedicle carrying the different size flap in pigs.Comparing the flap’s survival area of each group and the difference of flap survival-related factors .Through statistical analysis ,to discover changes of each group indicators and the survival mechanism of the slender narrow pedicle flap . Then drawing the conclusion ,to provide a theoretical basis for the clinical application of the slender narrow pedicle flap.Methods Making the animal random flap model . 25 pigs were randomly divided into 5 groups, There were 5 pigs in each group. The ratio of length to width of slender narrow pedicle in 5 groups respectively was: 0cm: 2cm, 1cm: 2cm, 2cm: 2cm, 3cm: 2cm, 4cm: 2cm, every ratio’s slender narrow pedicle was carrying five different sizes random flaps, which were 2cm×2cm,3cm×3cm,4cm×4cm, 5cm×5cm,6cm×6cm, and named A,B,C,D and E respectively. Flap A was control flap of B,C,D and E. In each group, flap A,B,C,D and E were created in each pigs’bilateral dorsum , the space of the flaps was 4cm,and the space between the pedicle and pig’s median line was 4cm . For reducing error, the flaps’sequence were arranged A、B、C、D、E on the one side of the pig’s dorsum , and in contrast on the other side.The flaps were evaluated with the general observation,fluorescence examination,blood flow ECT test,and computerized analysis of survival area. The full-thickness tissue specimen were cut down on the edge of each flap’s remote,which size was long (0.3cm)×width (0.3cm), at days 0, 3, 5, 7, and 14 after operation respectively. By HE staining, tissue microarray, immunohistochemical, enzyme-linked immunosorbent (ELISA) techniques ,and so on ,for the qualitative and quantitative analysis of CD34, TGF-β1, MDA, NOS in the flap.Results①The living process and pathologic process of traditional flap and slender narrow pedicle flap were consistent. It could not postpone the flap living process that the flap pedicle became long and narrow.②When the ratio of the length to width of the slender narrow pedicle was constant, along with the flap area increased, the flap survival area also increased, but when the flap reached a certain area , the distal flap would necrosis,the flap survival area would not reduce;③When the flap size remained unchanged, along with the ratio of the length to width of the slender narrow pedicle increased, the flap survival area was not affected, but, when the ratio of the length to width of the slender narrow pedicle increased to a certain limit, distal flap would necrosis, the flap survival area would reduce.④Histological analysis showed that, because of intraoperative tissual lesion ,the reaction of the hypoxia and ischemia ,the expression of MDA、TGF-β1 ,NOS and CD34 increased ; reached the plateau level at days 3、5、7 after operation respectively,and decreased to normal level after 14days.Conclusions①Pedicle width of random flap can be much smaller than flap width,the ratio of pedicle width to flap length is far less than traditional ratio;②The pedicle of random flap can be designed as slender shape ,so that the whole flap looks like "pingpang bat ", which makes the narrow pedicle flap rotate easily;③A certain ratio of the length to width of a slender narrow pedicle has a maximum flap survival area, and increasing the flap size or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis.④CD34, TGF-β1, MDA, NOS play important role in the survival process of the slender pedicle flap. MDA can reflect the degree of cell injury because of the flap ischemia and hypoxia. CD34, TGF-β1, NOS can improve the survival of the slender narrow pedicle flap. |
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